Allergy and immunology · London
Omalizumab (Xolair) for chronic urticaria - London.
A monthly subcutaneous biologic that quietens antihistamine-refractory hives and angioedema - prescribed by a consultant allergist or immunologist, given under BSACI observation protocols, with a proper step-down plan built in from day one.
Why patients choose us
- 01
A named consultant allergist or immunologist
Not a general dermatology clinic. A specialist who runs a dedicated urticaria service, with the experience to titrate, extend and step-down omalizumab.
- 02
The right diagnosis before the injection
We rule out inducible urticaria, urticarial vasculitis and autoinflammatory mimics before you commit to a year of monthly biologic therapy.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private omalizumab costs in London.
Indicative ranges across our London partner clinics. Send your UAS7 and antihistamine history and we quote firm figures across two or three options.
In short
A 12-month private course of omalizumab in London: £12,000–£20,000, with a 60–80% response.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant allergy or immunology assessment | £280–£450 | 45–60 min | Same visit |
| Baseline workup (IgE, TFT, coeliac, HBV serology) | £320–£520 | 15 min draw | 3–5 days |
| Omalizumab 300mg monthly injection (drug + admin) | £950–£1,600 | 2 hours | Same visit |
| Omalizumab 150mg monthly (lower-dose step-down) | £550–£900 | 2 hours | Same visit |
| 12-month course (12 injections, all-in) | £12,000–£20,000 | Monthly | Ongoing |
| Second-opinion urticaria review | £280–£450 | 45 min | 48 hours |
Prices vary by clinic, by whether the drug is sourced in-house or on a private prescription, and by observation and consultant fees. NHS omalizumab is available for eligible patients under TA339 but waiting lists vary.
The problem
The right diagnosis, the right dose, the right step-down.
Omalizumab is a humanised monoclonal anti-IgE antibody, brand name Xolair, made by Novartis and Genentech. It binds free IgE and prevents it attaching to mast cell receptors - which quiets the histamine cascade behind chronic urticaria. It is licensed for allergic asthma, chronic spontaneous urticaria, CRSwNP and food allergy.
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Is it really CSU?
Urticarial vasculitis, autoinflammatory syndromes and hereditary angioedema all mimic CSU. Get the diagnosis right before starting a year of biologic.
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Have antihistamines had a fair go?
Standard-dose then up to four-times standard-dose H1 antihistamine for 2–4 weeks is the gate. NICE TA339 and BSACI both require it.
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Is there a plan to stop?
A biologic without a step-down plan is a subscription, not a treatment. We plan the exit at the same visit we plan the start.
The journey
From first message to step-down - what happens, in order.
One team from enquiry to the year-end review. Given every four weeks; loading dose typically 300mg; response usually within 2–4 doses.
Phase 1 · Before your injection
Concierge, off-stage for you
Phase 2 · On the day
Two to three hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You send us the story and UAS7
A short, confidential form. Duration of hives, angioedema episodes, current antihistamines and doses, and a baseline Urticaria Activity Score over 7 days.
- 02
Before
We come back with a recommendation
Within one working day: whether omalizumab fits, or whether an antihistamine trial or workup should come first. Indicative price for the year.
- 03
Before
Baseline workup and consent
Total IgE, thyroid antibodies, coeliac screen if diarrhoea and hepatitis B serology. Full consent covering the rare anaphylaxis risk and the two-hour observation.
- 04
On the day
Arrival at the clinic
A short review with the consultant, blood pressure, and preparation of the two 150mg pre-filled syringes for a 300mg loading dose.
- 05
On the day
The injection itself
Two subcutaneous injections into the upper arm or thigh. Two-hour observation after the first three doses per BSACI guidance, shorter thereafter.
- 06
On the day
Home the same afternoon
A short recovery, written aftercare including anaphylaxis red flags, and home within two to three hours.
- 07
After
Repeat UAS7 and step-down plan
Monthly injections for six to twelve months, UAS7 at every visit, then a structured step-down with extended intervals or dose reduction.
Typical time to response: 2–4 doses. Full course: 6–12 months. Step-down: structured.
When it helps
Who is eligible - and who is not.
NICE TA339 covers adults with CSU unresponsive to standard-dose H1 antihistamines and unresponsive to a four-times standard-dose trial. BSACI supports specialist paediatric use from age 6. Trigger is poor quality of life: UAS7 above 16 or CU-Q2oL impact.
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Chronic spontaneous urticaria (CSU)
Daily or near-daily hives and itch for six weeks or more, with no identifiable external trigger, poorly controlled on standard antihistamines.
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Antihistamine-refractory disease
Persistent wheals despite a standard-dose H1 antihistamine, and still uncontrolled after a four-times standard-dose trial for two to four weeks.
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Recurrent angioedema without hives on its own
CSU with prominent lip, eyelid or hand swelling. Bradykinin-mediated (hereditary) angioedema is excluded first, as omalizumab is the wrong drug there.
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Chronic inducible urticaria overlap
Cold, cholinergic, delayed pressure or symptomatic dermographism layered on top of CSU, where physical avoidance alone is not enough.
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Poor quality of life on UAS7 or CU-Q2oL
A weekly Urticaria Activity Score above 16, or a CU-Q2oL score showing sleep, work or mood impact, is the trigger for biologic therapy.
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Paediatric CSU aged 6 years and above
NICE TA339 covers adults; specialist paediatric use in children aged 6 and above is off-licence but supported by BSACI when disease is severe.
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Steroid-dependent urticaria
Patients repeatedly rescued with oral prednisolone are prime candidates - omalizumab is the biologic that breaks the steroid cycle.
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Red flag: urticarial vasculitis
Wheals that last more than 24 hours in one spot, burn rather than itch, or leave bruising, need a skin biopsy - omalizumab is not the answer.
Protocol options
One drug, several rhythms - and a planned way to stop.
Dosing, observation and step-down. Efficacy in ASTERIA I, ASTERIA II and GLACIAL: 40–50% complete responders at 12 weeks, 60–80% partial or complete responders. Effect on wheal, angioedema, itch, sleep and quality of life is significant and sustained during treatment.
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Loading dose 300mg subcutaneous
Two 150mg pre-filled syringes given at the first visit. Most licensed adult CSU regimens start at 300mg, not 150mg, unless body weight and IgE dictate otherwise.
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Monthly maintenance every 4 weeks
Injections every 28 days for at least six doses before you judge failure. Response is usually visible within two to four doses; some late responders take longer.
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Two-hour post-injection observation
Recommended after the first three doses per BSACI, given the rare (<0.2%) risk of anaphylaxis. Observation shortens once you have tolerated the induction phase.
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Dose extension for good responders
Once wheals and itch are quiet on UAS7, we extend the interval to 5, 6 or 8 weeks rather than dropping the dose. Many patients keep control on longer intervals.
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Dose reduction 300mg to 150mg
An alternative step-down: keep the 4-weekly rhythm but halve the dose. Useful where an extended interval led to breakthrough between injections.
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Planned withdrawal after 6–12 months
A structured stop after a period of remission. About 30–50% remain in remission off treatment; the rest flare and restart, usually with the same response.
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Home self-injection
Once the induction phase is complete and tolerance shown, some patients are trained to self-inject at home to save clinic time - kept under specialist review.
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Ligelizumab and dupilumab in trials
Newer anti-IgE and anti-IL-4/13 biologics show promise for omalizumab non-responders. We discuss the current evidence and any UK trial access at your review.
Our vetted London network
A small panel of London urticaria specialists, we picked them.
Consultant allergists and immunologists at Chelsea and Westminster Private Allergy/Immunology, HCA The Wellington, Cromwell (BUPA), the London Allergy Clinic, The Portland Hospital and Great Ormond Street Hospital International Private for paediatric CSU.
Selection criteria
How we choose every clinic in our London network.
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Consultant allergists and immunologists running dedicated urticaria clinics
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BSACI-aligned protocols for induction, observation and step-down
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On-site anaphylaxis kit, resuscitation team and 2-hour observation capacity
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Access to skin biopsy, autoimmune serology and MDT if the diagnosis shifts
Safety and monitoring
What to expect afterwards - honestly.
Omalizumab is a well-tolerated biologic. Injection-site reactions, headache and viral upper respiratory infections are the common flags. Anaphylaxis is rare (under 0.2%) and the two-hour observation after the first three doses per BSACI is exactly there to catch it. There is no immunosuppression.
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Injection site reactions
The commonest side effect - redness, mild swelling and tenderness at the injection site for 24–48 hours. Settles on its own; ice and paracetamol are enough.
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Headache and viral URTI
Slightly commoner than placebo in the pivotal trials. Usually mild and self-limiting; no dose change needed unless persistent.
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Anaphylaxis - rare but real
Less than 0.2% of patients. Almost all reactions occur within two hours of the injection, which is why observation is mandatory during the induction phase.
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No immunosuppression
Omalizumab binds free IgE; it does not suppress T cells or antibody responses more broadly. Vaccinations and routine infections are managed as normal.
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Pregnancy and breastfeeding
EXPECT registry data is reassuring. Continuation in pregnancy is a shared decision with obstetrics and allergy - untreated severe urticaria is not benign either.
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Hepatitis B reactivation caution
Screen HBsAg and anti-HBc before starting. Reactivation has been reported with other biologics; check status and involve hepatology if positive.
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Malignancy signal not confirmed
An early signal of a small malignancy excess has not been borne out in long-term registry data. Discussed openly at consent, weighed against disease burden.
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No routine drug monitoring needed
Unlike cyclosporine, omalizumab needs no blood pressure, renal or drug-level monitoring. UAS7 at each visit is the main monitoring tool.
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Red flags after injection
Throat tightness, wheeze, dizziness, widespread flush or collapse within 24 hours - call 999 or return to A&E the same day, do not wait for clinic.
Reading your urticaria plan
Your CSU plan in four parts. Read the last one first.
Whichever clinic you attend, the treatment plan the consultant sends you keeps to the same shape.
A quiet reminder
Compared with cyclosporine, omalizumab gives 60–80% response without nephrotoxicity or blood monitoring.
Ligelizumab is in late trials, dupilumab evidence is emerging, and anakinra suits an autoinflammatory phenotype - we discuss all of them.
- 01 Header
Diagnosis, duration and current medications
Chronic spontaneous urticaria versus inducible urticaria, duration in weeks, angioedema history, current antihistamine dose and any rescue steroid use.
- 02 Scores
Baseline UAS7 and CU-Q2oL
Weekly Urticaria Activity Score with the wheal and itch components, plus the quality-of-life score. Repeated at every review to guide dose changes.
- 03 Workup
IgE, thyroid, coeliac, HBV serology
Total IgE baseline, thyroid antibodies (a recognised CSU association), coeliac screen if diarrhoea, and hepatitis B status before starting.
- 04 Impression
Dose, schedule and step-down plan
Read this first: the starting dose, interval, planned duration, criteria for extension or withdrawal, and the anaphylaxis plan on the day.
Recognised by major UK insurers
Cover for omalizumab varies by insurer and by indication - usually funded when NICE TA339 criteria are met. We confirm cover before booking.
Frequently asked
Everything we get asked about omalizumab.
Quick answers on response time, duration, insurance, paediatric use, stopping and side effects.
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How quickly does omalizumab work for urticaria?
Most responders notice a drop in wheal count and itch within two to four weeks of the first 300mg dose. Complete response is reported by 40–50% of patients by 12 weeks in the ASTERIA I, ASTERIA II and GLACIAL trials, and 60–80% show a partial or complete response. Some late responders only settle by dose 4–6, which is why we give a minimum of six months before judging failure.
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How long will I need to stay on omalizumab?
A typical course runs for 6 to 12 months of monthly injections, then a structured step-down with extended intervals (5, 6 or 8 weeks) or a dose reduction from 300mg to 150mg. About 30 to 50% of patients stay in remission after complete withdrawal; the rest flare and restart, usually with the same response as before.
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Will UK private medical insurance cover omalizumab?
Cover is variable. Most major insurers will fund omalizumab for CSU when NICE TA339 criteria are met (failed antihistamine trial, UAS7 above 16) and a consultant allergist or immunologist prescribes. Some restrict to a fixed number of doses. We confirm cover in writing before booking your first injection.
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Can children have omalizumab for urticaria?
NICE TA339 licenses omalizumab in adults for CSU. In children aged 6 and above, BSACI supports specialist off-licence use for severe, antihistamine-refractory disease with significant quality-of-life impact. It is prescribed and monitored in a paediatric allergy or immunology clinic, not in general practice.
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When and how do I stop omalizumab?
After 6 to 12 months of good control on UAS7, we plan a stop. Options are: extend the interval to 5, 6 then 8 weeks; drop the dose from 300mg to 150mg monthly; or stop completely. If hives return, restarting almost always works. Some patients cycle on and off across years - that is not a failure, it is a chronic disease.
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Are the side effects manageable in real life?
For the great majority, yes. Injection-site soreness, occasional headache and mild cold-like symptoms are the usual list. Anaphylaxis is rare, under 0.2%, and the two-hour post-injection observation during induction is there precisely to catch it. Unlike cyclosporine, there is no kidney or blood-pressure monitoring, and no immunosuppression.
Related treatments and tests
Looking for something else?
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Paediatric urticaria clinic
A dedicated clinic for children with chronic urticaria.
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Dupilumab for atopic dermatitis
IL-4/13 blockade for moderate-to-severe eczema.
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Skin prick allergy testing (paediatric)
Front-line paediatric allergy testing.
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Anaphylaxis management and EpiPen training
Adrenaline auto-injector training and rescue plan.
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Component-resolved allergy testing (ISAC/ALEX)
Molecular-level allergen profiling in one blood test.
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Ready to talk to a consultant allergist?
Send us your UAS7 and antihistamine history. We come back within one working day.
A named consultant, a proper baseline workup, a monthly injection under BSACI observation, and a step-down plan built in from the first visit.